Sedation Versus General Anesthesia for Ablation of Ventricular Arrhythmias: A Systematic Review and Meta-Analysis

Abstract

Ventricular arrhythmias (VA), including ventricular tachycardia and fibrillation, are critical cardiac conditions that are often managed by catheter ablation among those unresponsive to pharmacologic therapy. The choice of anesthesia and sedation regimens for VA ablations may impact arrhythmia inducibility and hemodynamic stability, which can affect procedural success and complication rates. This systematic review and meta-analysis aimed to compare the efficacy and safety of sedation versus general anesthesia (GA) among patients undergoing VA ablation. The review was prospectively registered on PROSPERO (CRD42023441553). Database searches were conducted across five major databases from inception to March 9, 2024 to identify randomized trials or observational studies including adult patients undergoing ablations for VA. Screening and data extraction were completed in duplicate. Risk-of-bias assessments were conducted using ROBINS-I as all included studies were observational, and the quality of evidence was evaluated using the GRADE framework. Six observational studies (N = 16,435) were included. No significant differences were found between sedation and GA for total procedure time (MD: -14.16 minutes; 95%CI: -38.61 to 10.29 minutes), arrhythmia non-inducibility (RR: 0.73; 95% CI: 0.33-1.58), acute ablation success (RR: 1.06; 95% CI: 0.65-1.71), or procedural complications (RR: 0.72; 95% CI: 0.28-1.85). However, sedation was associated with significantly lower intraprocedural hemodynamic instability (RR: 0.28; 95% CI: 0.12-0.70). These findings indicate that while sedation and GA have comparable outcomes, sedation may be associated with less hemodynamic instability during VA ablation. However, more high-quality studies are needed to confirm these results.

Keywords: Ablation; general anesthesia; sedation; systematic review; ventricular arrhythmia; ventricular tachycardia.

Figure 1

PRISMA flow diagram for the identification and selection of studies

Figure 2

Forest plot illustrating the individual and pooled relative treatment effects from meta-analysis for total procedural time. MD < 0 indicates beneficial treatment effects associated with sedation compared to GA. Abbreviations: MD Mean Difference, GA General Anesthesia, CI Confidence Interval

Figure 3

Forest plot illustrating the individual and pooled relative treatment effects from meta-analysis for dichotomous outcomes. For the outcome of arrhythmia non-inducibility, incidence of ablation complications, or incidence of intraprocedural hemodynamic instability, RR < 1 indicates beneficial treatment effects associated with sedation compared to GA. For the outcome of acute ablation success, RR > 1 indicates beneficial treatment effects associated with sedation compared to GA. (a) Arrhythmia non-inducibility. (b) Acute ablation success. (c) Procedural complications. (d) Hemodynamic instability during ablation procedure. Abbreviations: RR Risk Ratio, GA General Anesthesia, CI Confidence Interval, PVC Premature Ventricular Contraction, AM Activation Mapping, VT Ventricular Tachycardia, RF Radiofrequency (Ablation), PE Pericardial Effusion, PT Pericardial Tamponade, VF Ventricular Fibrillation